Actor-Network Theory and its role in understanding the implementation of information technology developments in healthcare

Abstract

BackgroundActor-Network Theory (ANT) is an increasingly influential, but still deeply contested, approach to understand humans and their interactions with inanimate objects. We argue that health services research, and in particular evaluations of complex IT systems in health service organisations, may benefit from being informed by Actor-Network Theory perspectives.DiscussionDespite some limitations, an Actor-Network Theory-based approach is conceptually useful in helping to appreciate the complexity of reality (including the complexity of organisations) and the active role of technology in this context. This can prove helpful in understanding how social effects are generated as a result of associations between different actors in a network. Of central importance in this respect is that Actor-Network Theory provides a lens through which to view the role of technology in shaping social processes. Attention to this shaping role can contribute to a more holistic appreciation of the complexity of technology introduction in healthcare settings. It can also prove practically useful in providing a theoretically informed approach to sampling (by drawing on informants that are related to the technology in question) and analysis (by providing a conceptual tool and vocabulary that can form the basis for interpretations). We draw on existing empirical work in this area and our ongoing work investigating the integration of electronic health record systems introduced as part of England's National Programme for Information Technology to illustrate salient points.SummaryActor-Network Theory needs to be used pragmatically with an appreciation of its shortcomings. Our experiences suggest it can be helpful in investigating technology implementations in healthcare settings.

Lost in translation? An actor-network approach to HRIS implementation

“…Examples include studies of the implementation of computer aided ambulance dispatch systems (McGrath, 2002), computerized baggage handling system in a major US airport (Mahring, Holmstrom, Keil, & Montealegre, 2004), health information systems (Cho, Mathiassen, & Nilsson, 2008;Cresswell, Worth, & Sheikh, 2010) inter-organizational information systems in a major Spanish seaport (Rodon, Pastor, Sese, & Christiaanse, 2008) an ICT enabled development project in Latin America (Andrade & Urquhart, 2010) and in relation to the deployment of CAD software across a number construction firms (Harty, 2010). Particularly notable are recent contributions by Elbanna (2008Elbanna ( , 2010 in which she uses an ANT framework to explain both project drift and the impact of other projects on the IS implementation, two issues that are relevant to the study of HRIS implementation and are evident in the case study we discuss below.…”

Benefit or burden? A sociotechnical analysis of diagnostic computer kiosks in four California hospital emergency departments

“…In contrast, a "sociotechnical" approach, informed by ANT, draws on qualitative methods to study technologies in the midst of the complex social and material networks that constitute e and are re-shaped e by them (Berg, 1999;Berg, Aarts, & van der Lei, 2003;Latour, 1988;Timmermans & Berg, 2003). Ethnographic methods can be particularly helpful in explaining implementation difficulties, non-use or unintended outcomes of technology projects (Cresswell, Worth, & Sheikh, 2010;Greenhalgh & Russell, 2010), and are increasingly recognized as a valuable approach to evaluating and building health IT projects and health care more broadly (Forsythe, 1992;Greenhalgh & Swinglehurst, 2011;Kaplan, 2001). In using ethnography to examine kiosk use and non-use, we examine how a material device and its adjoining representational system became entangled in, and were transformed by, the complex sociality and decision making processes at several busy EDs.…”

“…In other words, eligibility rates were of concern to researchers and hospital administrators mainly as a type of clinical "output", but for nurses the production of ineligible patients did not act as a mere absence or a signal to return to routine practice. Rather, low output actually disrupted the pragmatic work of triage, which illustrates how technology operates as an active participant in medical work even when it appears to be passive or dormant (Cresswell et al, 2010).…”

New structured knowledge network for strategic decision-making in IT innovative and implementable projects

“…This differentiation is beneficial to social issues in which outcomes are most frequently unpredictable (Underwood, 2008). IS studies also use ANT to facilitate the interpretation of the political processes of IT innovation and implementation (Cresswell et al, 2010). However, scholars rarely use ANT to explore knowledge sharing and transfer issues, especially knowledge networking and mobilization in a multi organization context to facilitate the smooth flow, tracing, and integration of knowledge (Erden et al, 2014).…”